EFFECTS OF COMMON CHEMICALS ON POPULATIONS

The effects produced by chemicals can be acute or chronic. The acute effects can manifest shortly
after exposure. The chronic effects can be delayed several months to years after exposure. Exposure
can produce generic effects in the form of allergic reactions, burns, asphyxia, irritation to the skin
and mucosal surfaces or acute systemic effects on specific target organs.

The common chemicals belong to the following five groups:

1) Dust/Fumes/Gases
2) Acid/Bases
3) Pesticides
4) Solvents
5) Metals

Toxidrome refers to a constellation of signs and symptoms that point to a broad class of possible
toxins. The three main acute syndromes that need to be recognized are:

1) Respiratory toxidrome
2) Dermal toxidrome
3) Neurological toxidrome

Respiratory Toxidrome

The effects from exposure to toxins via the respiratory tract include asphyxiation, irritant effects,
allergic reactions and systemic effect specific to the toxin. This can be classified into upper and lower
airway effects depending on the water solubility of the agents.

- Upper airway: Sneezing, rhinitis, coughing, throat irritation, hoarseness, injected throat,
stridor
- Lower airway: coughing, sputum, shortness of breath, chest pain, tachypnoea, wheeze,
crepitations

Dermal Toxidrome

This is due to effects from exposure to toxins on the skin. The ocular toxidrome is an extension of
the dermal toxidrome to involving the eye.

- Skin: pruritis, pain, rash, burns

- Eye: pain, tearing, blurring or loss of vision, photophobia, blepharospasm, injected
conjunctiva, corneal clouding or opacification

Neurological Toxidrome

The effects of toxins on the central nervous system can be direct or indirect due to secondary effects
such as hypoxia. Symptoms include altered mental states, depression, agitation, headache,
giddiness, weakness, nausea and vomiting.

Other Toxidromes
The other toxidromes involving gastrointestinal, hepatic, renal and haematological often result in
delayed presentations.

- Gastrointestinal: anorexia, nausea, vomit, diarrhea, abdominal pain

- Hepatic: jaundice, liver failure
- Renal: haematuria, renal impairment and failure
- Haematologic: depression of cell lines leading to fatigue, infections, bleeding

The potential for delayed effects after a latent period has important implications for interval triage
on these casualties and the need for rigorous surveillance in the exposed population. Some
examples of chronic effects include mutagenesis, carcinogenesis, teratogenesis or organ toxicity.
Some of these effects are reversible depending on the ability of the body to repair the damage done.

Some chemicals are more toxic than others. The toxicity of a chemical may be described by the types
of effects it causes and its dose and toxic potency. Toxicity is also influenced by the route and length
of exposure.

•Types of Effects: Different chemicals cause different effects. For example, Chemical A may cause
vomiting, but not cancer. Chemical B may have no noticeable effects during
exposure, but may cause cancer years later.

•Toxic Potency: Toxic potency refers to the ability of the chemical to cause a particular effect. When
referring to toxicity effects potency is seen as a measure of a chemical's toxicity.
The more toxic a chemical is, the more potent it is said to be. For example, sodium
cyanide is more toxic than sodium chloride (table salt) since swallowing a smaller
amount of cyanide can cause death. The toxic potency of a chemical can be
influenced by how the human body metabolizes it. Following absorption into the
body, the structure of a chemical may be modified to a substance that is more toxic
or less toxic. A chemical can produce the harmful effect associated with its toxic
properties only if it reaches a susceptible biological system within the body in
significant doses. As the dose (or exposure) increases the toxic effect of a substance
increases. All chemicals will demonstrate a toxic effect given a large enough dose. If
the dose is low enough even a highly toxic substance will cease to cause a harmful
effect. The greater the amount of a substance a person is exposed to, the more
likely that health effects will occur. Large amounts of a relatively harmless
substance can be toxic. For example, two aspirin tablets can help to relieve a
headache, but taking an entire bottle of aspirin can cause stomach pain, nausea,
vomiting, headache, convulsions or death. The toxic potency of a chemical is thus
ultimately defined by the dose (the amount) of the chemical that will produce a
specific response in a specific biological system.

•Exposure: A chemical can cause health effects only when it contacts or enters the body. The effects
may be felt at the portal of entry or the target organs reached by the chemical. The
portals of entry for chemicals into the human body could be by inhalation, ingestion or
direct contact.
  Inhalation (breathing) of gases, vapors, dusts or mists is a common route of exposure.
Chemicals can enter and irritate the nose, air passages and lungs. They can become
deposited in the airways or be absorbed by the lungs into the bloodstream. The blood can
then carry these substances to the rest of the body.
 Swallowing of food, drink or other substances (ingestion) is another route of exposure.
Chemicals that get in or on food, cigarettes, utensils or hands can be swallowed. Children
are at greater risk of ingesting substances found in dust or soil because they often put their
fingers or other objects in their mouths. Lead in paint chips is a good example. Substances
can be absorbed into the blood and then transported to the rest of the body.
 Direct contact (touching) with the skin or eyes is also a route of exposure. Some substances
are absorbed through the skin and enter the bloodstream. Broken, cut or cracked skin will
allow substances to enter the body more easily. Industrial chemicals such as chlorine gas
and organophosphates are prime examples of substances that are absorbed either through
the skin or eyes and even across mucous membranes.
 The route of exposure can determine whether or not the toxic substance has an effect.
Breathing in lead fumes or swallowing lead salts can result in health effects, but touching
lead is not harmful because lead isn't absorbed through the skin. Iron is not toxic when it
comes into contact with the skin. When taken in small doses it has health giving effects.
However, when taken in very large quantities it can be toxic and cause effects to many
organ systems.

•Length of exposure: Both acute and chronic exposure to chemicals may cause adverse health
effects that may be either immediate or that may not occur for some time.

Acute or short-term exposure is a short contact with a chemical. It may last a few seconds or a few
hours. For example, it might take a few minutes to clean windows with ammonia, use nail polish
remover or spray a can of paint. The fumes inhaled during these activities are examples of acute
exposures.

Chronic exposure is continuous or repeated contact with a toxic substance over a long period of time
(months or years). Over time, some chemicals, such as arsenic and lead, can build up in the body and
cause long-term health effects. Chronic exposures can also occur at home. Some chemicals in
household furniture, carpeting or cleaners can be sources of chronic exposure.

Chemicals leaking from landfills (dumps) can enter the groundwater and contaminate nearby wells
or seep into basements. Unless preventive measures are taken, people may be exposed for a long
time to chemicals from their drinking water or indoor air.

Reference:

1) HAZMAT Medical Life Support: A Basic Provider Manual. Chapter 4 Introduction to Industrial
Chemicals.